Abstract

BACKGROUND:

Patients want electronic access to providers. Providers fear being overwhelmed by unreimbursed messages.

OBJECTIVE:

Measure the effects of patient-physician web messaging on primary care practices.

DESIGN/SETTING:

Retrospective analysis of 6 case and 9 control internal medicine (IM) and family practice (FP) physicians' message volume, and a survey of 5,971 patients' web messaging with 267 providers and staff in 16 community primary care clinics in the Sacramento, CA region.

MEASUREMENTS AND MAIN RESULTS:

Case telephone volume was 18.2% lower (P=.002) and fell 6.50 times faster than control. Case total telephone plus web message volume was 13.7% lower (P=.025) and fell 5.84 times faster than control. Surveys were responded to by 40.3% (1,743/4,320) of patients and 61.4% (164/267) of providers and staff. Patients were overwhelmingly satisfied and providers and staff were generally satisfied; both found the system easy to use. Patient satisfaction correlated strongly with provider response time (Gamma=0.557), and provider/staff satisfaction with computer skills (Gamma=0.626) (Goodman-Kruskal Gamma [Gamma] measure of ordinal association).

CONCLUSIONS:

Secure web messaging improves on e-mail with encryption, access controls, message templates, customized message and prescription routing, knowledge content, and reimbursement. Further study is needed to determine whether reducing telephone traffic through the use of web messaging decreases provider interruptions and increases clinical efficiency during the workday. Satisfaction with web messaging may increase patient retention.